It is time for health professionals to work with, not against, the Health and Social Care Bill, now that it is closer to becoming an Act of Parliament. The legislation has many serious flaws, not least the abolition of local health authorities in England. However, doctors, health care providers and patients now have little alternative but to face up to the brave new world of the NHS marketplace.
Labour, as much as the Coalition, must take the blame, as it introduced GP commissioning and the privatisation of primary care. With PCTs already largely gone, doctors and associated health professionals must learn to create a "customer"-led NHS. Patients must become more assertive and speak up at every consultation, becoming active players in this NHS marketplace.
The Frankenstein's monster created under successive NHS reforms has left the operating table and is already at large.
Anthony Rodriguez, Staines, Middlesex
Demand (as opposed to clinical need, and driven by a complex mixture of factors) is exceeding available resources (financial and otherwise, and determined ultimately by central government) by an ever increasing margin, and only a fundamental change in the way we provide health care can have any hope of addressing this issue.
Unlike most of your correspondents, I do not perceive the Health Bill as an open door to privatisation. To me, it offers a chance to introduce meaningful local ownership of health care by all – not just clinicians and managers, but the public itself, and, if done properly, the lines of accountability will be to those local communities, in their most inclusive sense.
Adrian Canale-Parola, Rugby, Warwickshire
NHS reorganisations repeatedly fail because they treat symptoms and not the cause. The cause is systemic.
Whistleblowers are victimised because they appear anti-organisation. The perceived priorities of organisations are often put in front of the primary care needs of elderly patients. "Not going through the right channels" is considered a very serious offence and most NHS staff are simply too frightened to speak out for fear of their jobs.
A systemic cure could be remarkably simple. Whistle blowing, in certain circumstances, could be explicitly included in all contracts of employment from hospital porter to NHS Trust board members.
Charles Cawley, Leominster, Herefordshire
I couldn't be more disappointed at your statement that "the truth is the NHS is in urgent need of reform" (leading article, 10 October). No it's not, it's in urgent need of being left alone to evolve.
All organisations need to have built-in audit techniques, particularly an enormous organisation like the NHS. Audit should cover all aspects of how the organisation works, clinically, managerially and administratively. However, the last thing it needs is for everything to be thrown up in the air every few years to satisfy the ego of a politician.
Geoff Harris, Warwick
Apprenticeships to match academic career path
Your leader (13 October) rightly draws attention to the need to expand and reform apprenticeships. This government is doing exactly that – with record investment set to deliver some 360,000 apprenticeships this year alone. But we must, and will, do more, funding at least 250,000 more apprenticeship places than Labour planned.
Because I recognise that many of the young unemployed need extra support to help them make the grade of a full apprenticeship, I have introduced a new Access to Apprenticeships programme that will provide 10,000 such opportunities – including work experience and help with basic skills – every year.
To build social mobility and feed economic growth we need an apprenticeship programme, at the heart of a vocational pathway that matches the quality and seductiveness of the well-trod academic one. We will make it easier for employers to take on apprentices, while taking action to maintain the highest standards of training. I have already reduced red tape for large firms, and I will soon announce more action to simplify the system for smaller ones.
To build a truly sustainable economy we must have regard for practical and technical accomplishments, so neglected in the ephemeral growth of the boom years, at long last recognising the role they play in fuelling the economy and nourishing the common good.
John Hayes MP, Minister of State for Further Education, Skills and Lifelong Learning, Department for Business, Innovation and Skills
Youth unemployment is set to hit 1 million. This landmark represents skills wasted, talents squandered, a whole generation who are being let down and abandoned. But the Government's current programme offers no hope of relief from this. Instead of creating jobs, they are taking the axe to hundreds of thousands of public-sector posts. This can only exacerbate the problem.
Whether by politicians or press, the unemployed have frequently been given unfair labels such as "lazy" or "scrounger". But as we write, around 30 unemployed youth are currently just over 100 miles into a 330-mile "Jarrow to London March". Lazy they certainly are not.
We fully support these young marchers and their demands, including a massive government scheme to create socially useful jobs. They stand in the proud tradition, laid down by the 200 men who completed this same route in 1936, of fighting for the right to work.
We will be joining the final leg of the march on Saturday 5 November in Central London. We will join the thousands expected to turn out as we march from Temple embankment past Downing Street to rally in Trafalgar Square. Today's youth don't deserve to be thrown on the scrap heap.
Mark Serwotka, General Secretary, Public and Commercial Services Union
Bob Crow, General Secretary, Rail Maritime and Transport Union
Matt Wrack, General Secretary, Fire Brigades Union
No choice but to risk oil drilling
I read with little surprise your headline (12 October) "BP to risk worst oil spill in Shetlands drilling." Our demand for fossil fuels is insatiable, despite the messages we all receive about global warming and the desperate need for sustainable energy sources. Demand is outstripping supply. The UK is becoming more and more dependent on foreign supplies. BP is right to look to oil and gas deposits close to the UK and deep wells are a necessary part of that.
Risk is inherent to business. It is often those organisations that have failed to manage risk historically who make the best risk managers for the future. Realistically, BP has no future at all if messes up again.
Andy Stocks, Leeds
The harm done by drug prohibition
Chris Bryant says he has tried "very very hard to be liberal on drugs policy" (Opinion, 8 October). Try harder, Chris. It might help to move the "thousands of displaced people in Columbia [and] villagers caught in the crossfire between rival gangs in Mexico" to the other side of your internal debate. The suffering of these people is caused by the illegality of the drugs trade.
The same issue of The Independent reported that a 14-year-old Australian tourist faces six years in jail if convicted of trying to buy a little pot on the street in Bali. Has his life been ruined because he smokes cannabis or because it is illegal?
Geoffrey Cush, Brighton
Mysteries of college finance
"What happens to student fees?" asked Roger Moss (letter, 5 October). Like Mr Moss, I taught in UK higher education for 30 years and I often asked similar questions.
"Why are there no published accounts?" I frequently asked the senior management, probably to the detriment of my career. The answers I got were along the lines of "... academic freedom ... blah... confidentiality... blah ... not possible blah, blah, blah..."
But in this new spirit of localism and freedom of information, wouldn't it make perfect sense for all public-sector institutions to be required to publish a full set of accounts every year, just like a private company? This would include schools, universities, police forces, hospitals and so on.
Chris Payne, Lincoln
Bank auditors share blame
As a chartered accountant, I was appalled to read Dr Nigel Sleigh-Johnson's rather dismissive reply to Mr Howard's letter about the financial crisis (6 October). The "wildly optimistic" lending was sitting as an asset on the lender's balance sheet. It is a primary duty of auditors to test the veracity of such loans.
If the lending were "wildly optimistic", it would have been very easy for the auditors to detect such bad loans. Auditors are clearly not to blame for the initial lending but Mr Sleigh-Johnson does not remotely attempt to answer Mr Howard's point: namely, why did the auditors not blow the whistle?
Christopher Yaxley, Shrewsbury
On his current form David Cameron could soon become known as the "Standby Prime Minister". He stood by Andy Coulson with a loyalty that boomeranged spectacularly. He stood by Theresa May, whose "cat" anecdote at the Tory party conference will surely come back to claw her. Even more defiantly he stands by his beleaguered Defence Secretary, Liam Fox, whose job appears to be teetering on a tighrope. With friends like these, who needs enemies?
Donald Zec, London W14
I can assure John Walsh that aspartame is not harmless for everybody (6 October). If I inadvertently consume aspartame I get a blinding migraine. I am not allergic as far as I know to anything else but know I am not alone in being allergic to aspartame and I do think that bottles that contain it should carry a prominent warning.
Richard Noble, Tewkesbury, Gloucestershire
The English are always poking fun at the Académie Française "language police" ("Language watchdog goes interactive to teach French to the French", 12 October). Languages have "high" forms and control them with prescriptive rules. Arabic does, Japanese does, probably every language with enough speakers to differentiate into dialects does, and what is slightly ridiculous is that English pretends it doesn't.
Guy Ottewell, Lyme Regis, Dorset
We used to have a gentleman's game for hooligans, usually regarded as football, and a hooligan's game for gentlemen – rugby union. After events at the Rugby World Cup, the latter has become the hooligan's game for hooligans.
Madge Alsto, Claydon, SuffolkReuse content